Form Ldss 3668 – Fill Out and Use This PDF

The LDSS-3668 form, also known as Shelter Verification, serves a critical role in the evaluation of assistance cases by requesting information on household composition and shelter expenses directly from landlords or shelter providers. It is designed to collect comprehensive details to ensure the accurate assessment of an individual's or family's needs without implying any obligation on the agency's part. For those looking to complete their assistance case evaluation, clicking the button below to fill out the LDSS-3668 form effectively is highly encouraged.

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Form Ldss 3668 PDF Details

Providing secure and stable shelter is a foundational aspect of ensuring the well-being of individuals and families navigating financial challenges. The LDSS-3668 form, a critical document issued by local districts, plays a pivotal role in this process. It is primarily used to verify the shelter situation of persons applying for or receiving assistance, ensuring that their living conditions and associated expenses are accurately documented. This form requests detailed information about the dwelling type, household composition, and shelter costs, including utilities and rent. It also inquires about the potential for employment opportunities for members of the household and whether any members provide services for reduced rent. Additionally, the LDSS-3668 form covers the specifics of the landlord or owner of the property, providing a clear channel of communication between the agency and the individual or family's housing provider. By filling out this form, landlords and tenants facilitate a transparent evaluation of housing needs, which is crucial for the agency to offer the appropriate level of support. The cooperation of all parties in completing the LDSS-3668 form is essential for the timely and effective delivery of assistance, underpinning the agencies' commitment to preventing homelessness and promoting housing stability.

Question	Answer
Form Name	Form Ldss 3668
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	shelter verification form, ny shelter verification, otda form shelter, dss shelter verification form

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LDSS-3668 (Rev. 2/10)

SHELTER VERFICATION

Local District Name and Address:

Case Number:

Worker ID:

Case Name and Address:

Dear Sir/Madam:

We are currently reviewing the assistance case of the above named person. In order to complete our evaluation of this case, we need information regarding household composition and shelter expenses. This form is for verification purposes only, and does not imply any obligation on the part of this Agency.

Please complete this questionnaire beginning with Section A below. Thank you for your cooperation.

SECTION A: SHELTER DESCRIPTION

Address:_______________________________						Type of Dwelling (Check One)

				Hotel/Motel			Room in Private Home
				Hotel/Motel			Room in Private Home
City:__________________________________				Apartment		(# ____ )	Commercial Rooming House
				Apartment		(# ____ )	Commercial Rooming House
							Are Meals Included?
Zip Code:______________________________				House		Trailer		Yes		No
Zip Code:______________________________
				No. of Bedrooms: ____			Is any part of the room rent used
County:________________________________							for heat or utilities?
County:________________________________								Yes		No
								Yes		No

		SECTION B: HOUSEHOLD COMPOSITION

Number of people living in this rental unit: ______________

Names	How long has this person lived					Names		How long has this person lived
Names		here?				Names			here?
		here?							here?






Does anyone listed above have a telephone?			Yes No		Is anyone listed above employed?				Yes	No
Number: ________________________________________					Name: _________________________________________
					Employer:_______________________________________
Does anyone listed above perform any services for you for					Do you have any employment opportunities for a member
which he/she receives a lower rent?		Yes	No		of this household?		Yes		No
If yes, explain: ___________________________________					If yes, explain: ___________________________________

SECTION C: SHELTER EXPENSES

Rental Amount: $______________________________________					Is rent paid up to date?	Yes	No
Due:	Weekly	Monthly	Every 2 weeks	Twice a month	Last month that rent was paid in full: ___________

Name of person(s) paying rent: ___________________________					Is rent subsidized? (e.g. HUD)	Yes	No
Name of Tenant of Record: ______________________________					If yes, amount subsidized: ___________________
(If different from person paying the rent)					Subsidizing agency: ________________________

Check the following which are included in the rent:
Heat	Electricity		Hot Water	Air Conditioning		Furniture	Garbage Collection
Stove	Refrigerator		Water/Sewer	Cooking Fuel		Meals	Heating Equipment
If heat is NOT INCLUDED in rent, check the primary type of fuel used for heating :
Natural Gas	Kerosene		Propane		Coal	Wood	Electricity	Oil

Does the furnace/stove heat:
Only this apartment		Entire House		Other (Specify): ________________________________________

Does the tenant pay to you an amount, separate from the rent, for heat?
Yes	No	If yes, list monthly amount:_______________________
		If no, does the tenant pay the vendor directly for heat?					Yes	No

Does the tenant pay to you an amount, separate from the rent, for water?
Yes	No	If yes, list monthly amount: _________________________________________________

Does the tenant pay to you an amount, separate from the rent, for other non-heating utilities?
Yes	No	If yes, list monthly amount: _________________________________________________

If tenant pays for non-heating utilities, are there separate meters for the tenant’s apartment?
Yes	No

To your knowledge, does anyone that lives outside of the household pay all or part of the rent and/or utilities?
Yes	No	If yes, please explain: _____________________________________________________

			SECTION D: LANDLORD INFORMATION

Does Landlord live in the same apartment/ rental unit as					Date Tenant moved in / will move in:
Does Landlord live in the same apartment/ rental unit as
tenant?	Yes		No

Relationship to Tenant:					Landlord’s Name:

Landlord’s Address:					Landlord’s Telephone Number:

Landlord’s Signature:					Landlord’s E-mail Address:

Date:					Owner’s Name (If different than landlord):

Owner’s Address:					Owner’s Telephone Number:
					Owner’s E-mail Address:

How to Edit Form Ldss 3668 Online for Free

It is possible to fill in ny shelter verification effortlessly in our online editor for PDFs. The editor is continually improved by our team, acquiring additional features and growing to be a lot more convenient. Starting is effortless! All that you should do is adhere to these simple steps directly below:

Step 1: First of all, open the pdf tool by clicking the "Get Form Button" at the top of this site.

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It's easy to complete the pdf using out practical tutorial! Here is what you have to do:

1. To begin with, while completing the ny shelter verification, start with the page that includes the next blank fields:

Completing segment 1 in ldss 3668 shelter verification

2. When this array of fields is filled out, proceed to type in the applicable details in these - Address City Zip Code County, No of Bedrooms, Is any part of the room rent used, for heat or utilities, Yes No, SECTION B HOUSEHOLD COMPOSITION, Number of people living in this, Names, How long has this person lived, here, Names, How long has this person lived, here, Does anyone listed above have a, and Does anyone listed above perform.

Simple tips to fill in ldss 3668 shelter verification portion 2

Be really mindful when filling in No of Bedrooms and Does anyone listed above have a, since this is the part in which many people make a few mistakes.

3. The following step is all about Does anyone listed above perform, Yes, Is anyone listed above employed, and Yes - fill in each of these fields.

Best ways to prepare ldss 3668 shelter verification stage 3

4. It's time to fill in this fourth form section! Here you'll have these SECTION C SHELTER EXPENSES, Rental Amount Due, Every weeks, Monthly, Weekly, Twice a month, Name of persons paying rent Name, Hot Water, WaterSewer, Electricity, Refrigerator, Stove, Heat, Is rent paid up to date Yes No, and Is rent subsidized eg HUD Yes No form blanks to fill in.

Part # 4 of submitting ldss 3668 shelter verification

5. The last step to finalize this document is essential. Make sure you fill out the displayed blank fields, such as Does the tenant pay to you an, Yes, No If yes list monthly amount, If no does the tenant pay the, Yes, Does the tenant pay to you an, Yes, If yes list monthly amount, Does the tenant pay to you an, Yes, No If yes list monthly amount, If tenant pays for nonheating, Yes, To your knowledge does anyone that, and Yes, before submitting. Failing to do this can generate an unfinished and possibly incorrect form!

ldss 3668 shelter verification completion process explained (step 5)

Step 3: Glance through all the information you've inserted in the blanks and click on the "Done" button. Create a 7-day free trial option with us and obtain immediate access to ny shelter verification - download, email, or edit inside your personal account. Here at FormsPal.com, we do our utmost to make sure all of your details are stored private.

Form Ldss 3668 – Fill Out and Use This PDF

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